By Dr. Erlantz Hyppolite, Surveillance Study Manager, NASTAD Haiti, and Anna Carroll, Associate, Global Program, NASTAD
“We cannot win the battle against AIDS if we do not also fight TB.”
– Nelson Mandela, XV International AIDS Conference, Bangkok, Thailand
Nelson Mandela was one of many who emphasized the importance of targeting the tuberculosis (TB) epidemic as part of the global effort to fight and eliminate HIV and AIDS. In Haiti, NASTAD staff are working throughout the country to do just that. In Haiti today, an estimated 150,000 people are living with HIV, corresponding to 2.1% of the adult population. Compounding the burden of HIV in this country is an aggressive TB epidemic: it is estimated that 30,000 people are living with TB in Haiti, and an estimated 20% of those TB patients are known to be HIV positive. In 2012 alone, there were 4,300 new cases of HIV and TB co-infection. TB is one of the most common causes of death among people living with HIV, and the co-epidemic of HIV and TB poses an enormous challenge in communities throughout Haiti.
While these statistics give us a sense of the severity of the HIV and TB co-epidemic in Haiti, they paint an incomplete picture; it is estimated that as many as 40% of people living with TB in Haiti remain undiagnosed. The Haiti Ministry of Health (MoH) has made it a priority to gather stronger, more comprehensive data on these diseases in order to understand and combat them more effectively, with an ultimate goal of reducing TB prevalence by 25% by 2015. Recognizing the importance of addressing HIV and TB surveillance in a coordinated manner, the MoH began working with NASTAD in 2013 to develop a case surveillance system for TB that would be integrated into the existing HIV case based surveillance system that NASTAD played an integral role in developing and maintaining.
In March of 2013, NASTAD staff began a system expansion project which integrates active case based surveillance of TB into the existing national HIV surveillance structures and processes. To do this, NASTAD organized trainings in Port-au-Prince for key personnel working in TB clinics, including site managers, nurses, auxiliaries, and Disease Reporting Officers (DROs). Since March 2013, 134 people from 60 institutions throughout Haiti have been trained on the pilot case notification system developed to capture and follow up on diagnosed tuberculosis cases. During these trainings, participants learned about and discussed key concepts of case based surveillance, the importance of security and confidentiality, and the use of the electronic report form that is used to systematically report any new case of tuberculosis, as well as co-infection with HIV. One training participant, the nurse in charge of the TB clinic at Foyer St. Camille Hospital, described her support for the training and the new TB surveillance system: “The tuberculosis case based surveillance system will help me do a better job following my patients and also will help me be more accurate in the preparation of my case reports for the MoH National TB Program.”
Participants were also able to practice using both the online and offline reporting systems, and were given tools to help support regular reporting of new infections and co-infection. “The trainings were well received by the institutions that participated. Program managers now understand how the surveillance system will help the MoH to better gauge the impact of TB and TB/HIV co-infection by providing them with real time information about new cases. Institutions will also benefit, because the system will help them to better monitor and support their own patients,” explained Dr. Erlantz Hyppolite, NASTAD Surveillance Study Manager.
Dr. Hyppolite continued, “The system is now up and running and has already captured 759 unique cases from 38 institutions. More than 100 of these cases also tested positive for HIV. Follow up site visits will be very important to reinforce the new system and ensure data quality.” In January of 2014, NASTAD staff began conducting site visits to each of the 60 participating tuberculosis clinics in order to provide direct supportive supervision and technical support to staff responsible for TB case surveillance. Through the development of this system, NASTAD will help to build the capacity of the MoH to monitor the TB and HIV co-epidemic, which will support the compilation and use of stronger, more current data to inform the development of effective TB and HIV prevention, treatment, and care programs.
If you are interested in learning more about what NASTAD is doing in Haiti to improve HIV and infectious disease surveillance, strengthen health systems and build capacity, please contact Mark Griswold.